Abstract
IntroductionMultiple sclerosis (MS) is a heterogeneous disease with an unpredictable course. Visual pathway is a target of the disease and may reflect mechanisms that lead to disability. Structural and functional changes in the visual pathway may be studied by noninvasive techniques such as optical coherence tomography (OCT), visual evoked potentials (VEP), or B‐mode transorbital sonography (TOS).ObjectivesThe aim is to assess changes in the visual pathway in eyes of MS patients with and without a history of optic neuritis over a 3‐year period and to explore their relationship with disability.Materials and MethodsIn total, 112 eyes from 56 patients with relapsing MS were recruited: 29 with, and 83 without a history of ON (hON and nhON, respectively). Several parameters were measured by OCT, VEP, and TOS. Baseline measurements were also compared to 29 healthy controls. At 36 months, measurements were repeated in all eyes.ResultsAt baseline, all tests showed significant differences in optic nerve structure and function in both patient cohorts in all the parameters studied, suggestive of more impairment of the visual pathway among the hON cohort. OCT showed significant differences between healthy controls and the nhON cohort. At 36 months, the nhON cohort showed significant changes by OCT, VEP, and TOS suggestive of further visual pathway impairment. OCT measurements also correlated with baseline EDSS among the nhON cohort.ConclusionsOCT is the most suitable technique and outperforms VEP and TOS to detect subclinical damage in the visual pathway. It discriminated MS patients from healthy controls and showed a progressive decline in optic nerve thickness over time among these patients.
Highlights
Multiple sclerosis (MS) is a heterogeneous disease with an unpredict‐ able course
visual evoked potentials (VEP), optical coherence tomography (OCT), and transorbital sonography (TOS) discriminated MS patients with optic neuritis (ON) from those without it, suggesting that these techniques are sensitive enough to detect structural and/or functional changes produced in the optic nerve after an acute ON episode
Of the three techniques, OCT yielded the best performance and was the only that could discriminate between MS eyes without a history of ON and healthy controls, as depicted by the receiver operating characteristic (ROC) curve (Figure 1)
Summary
Multiple sclerosis (MS) is a heterogeneous disease with a variable clinical course. Much research has been focused on biomarkers that could predict patients' clinical course and long‐term disability. The aim of the study was to evaluate the suitability of these three techniques to monitor visual pathway changes over a 3‐year period in MS patients and to explore their relationship with disability. All eyes underwent VEP, OCT, and TOS measurements at base‐ line and at 36 months Correlation between these findings and clin‐ ical variables was explored. To ensure comparability of the cohorts, baseline demographic and clinical variables of the patients were collected and compared. Patients with and without a history of ON did not show significant differences in terms of clinical variables (disease duration, accumulated number of relapses, baseline EDSS, baseline MRI T2 lesion and T1 Gd—enhancing lesion count, and the presence of dis‐ ease‐modifying treatment). TA B L E 2 Healthy controls, nhON, and hON cohort baseline and 36‐month follow‐up measurements.
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